1. Field of the Invention
This invention relates to devices, systems and methods for arthroscopic examination and treatment and surgical examination and treatment, particularly in and near the hip joint. In particular, the invention relates to arthroscopic devices, systems and methods for performing arthroplasty of the hip joint and the region near to the hip joint, including computer and robotic assisted surgical navigation, and for resurfacing and other partial arthroplasty treatments in and near the hip joint.
2. Description of Related Art
The hip is vital to human locomotion, and hip injuries and diseases can significantly impact the ability of a patient to carry out day-to-day tasks as well as impair the performance of athletes and active amateur sports enthusiasts. Hip conditions impairing movement or causing pain with normal activity may result from trauma, age, or disease conditions.
Hip surgery is indicated where there is injury or change in the hip joint requiring removal or reshaping of bone or cartilage or of material present in the joint. Arthroscopic surgery causes the least amount of ancillary trauma and allows for more rapid recovery than do other forms of hip surgery. Arthroscopic treatment of the hip is discussed, for example, in Kelly et al., “Hip Arthroscopy: Current Indications, Treatment Options, and Management Issues,” American Journal of Sports Medicine 31(6):1020-1037 (2003). Hip joint replacement or hip joint arthroplasty is the partial or full substitution of the joint components with synthetic/man-made/biocompatible materials. Hip joint arthroplasty is generally performed when the function of the native joint is compromised by significant pain, loss of congruency, cartilage/bone loss, and lack of motion.
Osteoarthritis (OA) and its precursor chondromalacia are common diseases of the hip joint. Both conditions typically are a function of age, genetics, prior injury, and underlying joint pathomechanics. Treatment of significant chondromalacia and osteoarthritis is typically performed via an arthroplasty procedure where the diseased joint surface and surrounding bone is replaced with durable biocompatible materials, most commonly, metal alloys, plastic polymers, and ceramics, and, less frequently, organic and inorganic tissue replacements or scaffolds.
Arthroplasty procedures are performed throughout the world and are most commonly done on the hip joint. Arthroplasty techniques are varied, but share the same goal of removing the dysfunctional arthritic joint areas and replacing them with materials that preserve joint function. Specifically, hip arthroplasty procedures are intended to give the patient recipient a pain-free weight bearing joint whose motion replicates the native hip joint.
Arthroplasty procedures of the hip joint specifically target disease of the femoral head (ball portion) and acetabulum (socket portion). Traditional total hip replacement surgery amputates the femoral head and a portion of the femoral neck as well as the acetabulum. Resurfacing-type procedures amputate a portion of the femoral head as well as the acetabulum. Partial resurfacing procedures typically result in a portion of the femoral head being resected. Substituted in their place are materials that possess durability and function.
Surgical techniques to accomplish arthroplasty goals require an open rather than an arthroscopic approach. These open approaches may involve traditional full incision exposures such as the Smith-Peterson, Hardinge, or Watson Jones, or newer more limited incision exposures based on the traditional approaches such as the two-incision, mini-incision, and muscle splitting/sparing options. Regardless of the approach selected, open surgery is performed, resulting in greater iatrogenic soft tissue trauma.
The most common arthroscopic approach to the hip is from the anterior aspect of the thigh. The two arthroscopic portals from this approach are the anterior/mid anterior and anterior-lateral. Occasionally, other portals are utilized including the accessory lateral portal and posterior-lateral portal. Typically, a hip arthroscopy involves procedures within two compartments, the central and the peripheral. From the central compartment, the surgeon can address pathology of the labral and articular cartilages, the synovium point lining), and acetabular rim. From the peripheral compartment, the surgeon can address pathology of the femoral head and femoral neck junction. In addition to the central and peripheral compartments, extra-articular compartments exists about the region of the lesser and greater trochanters.
Although arthroscopic examination, evaluation, and treatment of the hip and hip region are common procedures, there is not a method or system for arthroscopic assisted hip joint arthroplasty. There is, therefore, a specific need for improved devices and methods and for improved arthroplasty treatments which lower the risk of iatrogenic injury, postoperative complications, and provide improved means for performing arthroscopic hip treatments and procedures.